MGUS monitoring

Monitoring strategy for patients with monoclonal gammopathy of undetermined significance (MGUS)

Patients diagnosed with MGUS require careful long-term monitoring to detect progression to multiple myeloma or related disorders. The appropriate strategy includes regular clinical assessment and laboratory investigations focusing on serum paraprotein levels and markers of disease progression.

Typically, initial monitoring should involve periodic serum protein electrophoresis and serum-free light-chain assays to quantify paraprotein and assess light-chain ratio abnormalities, which are crucial for risk stratification and early detection of progression NICE NG35. Clinical review should include assessment for any new symptoms potentially indicating progression, such as bone pain or signs of anaemia or renal impairment.

The frequency of monitoring is generally every 6 to 12 months depending on the patient’s risk profile. Lower-risk MGUS patients may be monitored less frequently, whereas those with higher-risk features (e.g., non-IgG MGUS, high serum M-protein levels, or abnormal free light-chain ratio) warrant closer surveillance NICE NG35. For example, monitoring every 6 months for the first year or two is often suggested, tapering to annually thereafter if the condition remains stable.

MGUS patients do not require routine imaging unless new symptoms develop, which would then prompt symptom-directed imaging to rule out bone disease or plasmacytomas NICE NG35. In contrast to smouldering myeloma or myeloma, skeletal surveys or whole-body imaging are not routinely indicated for MGUS monitoring unless clinically warranted.

Recent literature emphasizes that the monitoring interval may be individualized further based on emerging biomarkers and patient-specific risk factors but does not radically diverge from established guideline recommendations Sunil et al. 2026. Early identification of changes in paraprotein levels or light-chain ratios remains key in both guidelines and recent academic findings.